Montana continues to rank among the top 10 states for its Medical Liability Environment and has high levels of injury prevention funding and low racial and ethnic health disparities in infant mortality. However, the state is weak in statewide planning for Disaster Preparedness, quality improvement, and patient safety assurances.

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Strengths

Montana has one of the top Medical Liability Environments in the nation. The state has implemented many reforms that help protect its health care providers. Mandatory pretrial screening panels help ensure that meritless lawsuits do not go forward, and Montana's $250,000 medical liability cap on non-economic damages helps ensure that malpractice award payments will remain modest. Periodic payments are allowed upon request, and the state has partially reformed joint and several liability.

While faring poorly overall, Montana has improved somewhat in Public Health and Injury Prevention. With funds dedicated to injury prevention for both children and older adults, the state has the highest per capita level of injury prevention funding in the nation and has funding dedicated specifically for child and elderly injury prevention. It also has low fatality rates for bicyclists (1.8 per 100,000 cyclists) and pedestrians (2.7 per 100,000 pedestrians). Regarding health risk factors, Montana has better-than-average rates of adult and child obesity (24.6 and 14.3%, respectively) and a low infant mortality rate (5.9 per 1,000 live births).

Despite overall low scores for its Quality and Patient Safety Environment, Montana recently implemented a prescription drug registry, which is an important investment for the state in helping to curb illicit use of prescription drugs.

Challenges

Montana ranks second worst in the nation for its Quality and Patient Safety Environment, largely due to a lack of state-level policies that promote quality of care. The state does not have triage and destination policies in place for trauma, stroke, or ST-elevation myocardial infarction (STEMI) patients and lacks a uniform system of providing pre-arrival instructions. Such policies and procedures can help streamline care and ensure that patients receive the most appropriate and effective treatments before arrival at the hospital. While more than 75% of Montana's hospitals have electronic medical records, they have fallen behind most other states in the adoption of computerized practitioner order entry (59.6%).

Montana also lags in terms of Disaster Preparedness. While the state has high per capita federal Disaster Preparedness funding levels ($11.75 per person), it lacks some important statewide policies and procedures that would ensure a systematic approach to disaster response. Montana does not have a statewide patient tracking system or a syndromic surveillance system. It also lacks guidance in its medical response plan specifically for medically fragile patients, including patients dependent on dialysis, medication for chronic disease, or psychotropic medication.

In terms of Access to Emergency Care, Montana has comparatively high per capita rates of medical specialists and hospital facilities, despite being a large and rural state. However, there are some troubling gaps in their systems. The state has the second highest proportion of adults reporting an unmet need for substance abuse treatment (10.7%). Montana also has one of the highest rates of children without health insurance (12.3%), with unreasonable costs being reported by the parents of 20% of children with health insurance. The state also has a relatively high proportion of children who could not always see a provider when needed.

Recommendations

Montana is a large, rural state with independent counties and cities, but state-level policies and procedures that ensure patient safety, quality improvement, and Disaster Preparedness are important safeguards that can be applied at the regional or local levels. These policies help ensure that the state can monitor and respond to emerging health issues, conduct a coordinated disaster response, and ensure that medically vulnerable patients receive prompt and evidence-based care.

Public Health and Injury Prevention efforts in Montana need to be strengthened and expanded. Montana has very high rates of binge drinking (20.8% of adults), and 42.0% of the state's traffic fatalities are alcohol-related, pointing to a need for education and enforcement. The state also has the third highest rate of traffic fatalities (18.2 per 100,000 people); low seatbelt usage rates; and weak traffic safety laws related to adult seat belt use, child safety seats, and distracted driving. Reform of these laws and targeted enforcement could help improve the overall safety and health of Montana's citizens.